In recent years, the topic of fluoride-free toothpaste for children has increasingly come into focus. Many parents are asking whether they should replace fluoridated toothpaste with a fluoride-free alternative to avoid perceived health risks for their children. But what’s actually behind this debate? Is fluoride-free toothpaste really the better choice for children, or is it just a fad?
What is fluoride and why is it used in toothpaste?
Fluoride is a naturally occurring mineral used in many areas of dentistry. In toothpaste, fluoride is primarily known for its ability to prevent tooth decay by strengthening tooth enamel and making it more resistant to acids. Numerous scientific studies have clearly confirmed the effectiveness of fluoride in preventing tooth decay. According to a review by the American Dental Association (ADA), fluoride reduces the risk of tooth decay by up to 25% (ADA 2018).
Fluoride-free toothpaste for children: A growing interest
Despite the proven benefits of fluoride, more and more parents are opting for fluoride-free toothpaste. Especially with children who still have small teeth and often swallow large amounts of toothpaste, many parents fear a potential fluoride overdose. In high doses, fluoride can lead to health problems, such as fluorosis (a disorder of tooth mineralization). We have examined why this fear is unfounded, at least in Europe, and how to avoid the risk of (medically harmless) mild fluorosis in a separate article:
In fact, the amount of fluoride contained in toothpaste is generally harmless. Even for young children, who tend to swallow large amounts of toothpaste, the amount used does not represent a statistically measurable risk factor. Nevertheless, many parents, out of ignorance, prefer fluoride-free toothpaste to minimize the risk of accidental fluoride ingestion.
Fluoride-free toothpaste: Is it just as effective against tooth decay?
Scientific studies on the effectiveness of fluoride-free toothpaste are limited and often incomplete. For example, research has found that toothpastes containing alternative ingredients such as xylitol (a plant-derived sugar alcohol) or calcium phosphate may offer some protection against cavities.
A comprehensive study by Schulte et al. (2014) examined the effectiveness of fluoride-free toothpaste containing xylitol in children. The results showed that this toothpaste could indeed reduce the risk of cavities when used regularly. However, the level of protection against cavities was significantly lower than that of fluoride-containing products. Therefore, while fluoride-free toothpaste can provide some support for oral health, it does not offer the same level of protection as fluoride-containing toothpaste.
Another ingredient increasingly used in fluoride-free toothpastes is hydroxyapatite, a naturally occurring mineral that helps tooth enamel remineralize. However, scientific evidence for this is lacking; according to a study by medizin-transparent.at, alleged studies are so insufficient that they cannot provide any scientific proof of effectiveness.
When should children use fluoride-free toothpaste?
In principle, the recommendation from dentists and scientists is clear: Children should also use fluoride toothpaste, as it offers the only truly effective protection against cavities.
There is one exception, however: If children also take fluoride tablets, they should not also use fluoride toothpaste to reduce the risk of fluorosis. Fluorosis can occur if children ingest too much fluoride at a young age, especially during tooth development. Studies have shown that fluoride tablets are responsible for two-thirds of all fluorosis cases.
Taking fluoride tablets is still advisable, but only for babies before the first teeth emerge. After that, the use of fluoride tablets should be discontinued and switched to fluoride toothpaste. Anyone who still needs to give tablets – for whatever reason – should not also use fluoride toothpaste, but rather use a fluoride-free product. One fluoride-free toothpaste that is well-rated by consumers is Lavera’s Kids Fluoride-Free Toothpaste.
Which toothpaste for children?
Elmex children’s toothpaste contains a child-friendly amount of fluoride. (Image source: elmex). To prevent fluoridosis, children’s toothpastes in Germany usually contain a reduced fluoride content of 500 ppm. Parents are also advised to use only a pea-sized amount of toothpaste and to supervise their children’s brushing. Even if toothpaste is swallowed, the amount is safe and the risk of overdose is virtually nonexistent. One children’s toothpaste that has received excellent reviews from Stiftung Warentest, dentists, and consumers (the latter via Amazon reviews) is elmex children’s toothpaste, which is available in three different varieties:
- elmex-Zahnpasta Baby für Kinder von 0-2 Jahre
- elmex-Kinderzahnpasta für Kinder von 2-6 Jahre
- elmex-Zahnpasta Junior für Kinder von 6-12 Jahre
We also use this toothpaste for our own children, with excellent results. However, following our dentist’s recommendation, we started directly with the children’s toothpaste for ages 2-6, as the baby toothpaste contains too little fluoride to provide effective protection.
Conclusion: Fluoride-free toothpaste for kids – yay or nay?
Scientific studies support the effectiveness of fluoride in preventing caries, while fluoride-free toothpastes can only be considered an equivalent alternative in isolated cases. Therefore, the use of fluoride toothpaste is also advisable for children. Only if fluoride is already being absorbed through other means, such as tablets, should a switch to a fluoride-free toothpaste be considered. However, it makes more sense to stop taking tablets and use fluoride toothpaste.
Sources:
- American Dental Association. (2018). Fluoride: Nature’s cavity fighter. ADA.
- WHO. (2006). Fluoride in drinking-water. World Health Organization.
- Schulte, A.G., et al. (2014). Xylitol-containing toothpaste and its effect on the prevention of dental caries in children. Clinical Oral Investigations.
- American Academy of Pediatrics. (2017). Fluoride use in pediatric dental care. Pediatrics.